LSO K codes
Description
Collection
Title:
LSO K codes
Text:
Hello List
Thoughts on LSO K-codes
When discussing the LSO K-codes and allowables, it is hard to know where to
begin. First, new codes and descriptors were established to more narrowly
define how devices could be coded. Some of the new descriptors are relatively
straighforward crosswalks of previous codes, and some are indecipherable and / or
virtually identical to others. Then, allowables were established essentially
by finding inexpensive products that could be considered examples of codes,
and using the cost of those products plus a minimal markup as the new allowable.
I have a comment about one new code and allowable, and a question about three
others. In the current AOPA in advance, it is noted that allowables for
some of the codes have increased. One of these is K0637, which I interpret to
represent a typical lumbosacral corset with stays, formerly coded with L0500
with a 2003 allowable of $106.76 in Region B. The increased allowable is now
$67.53 (from 64.14), for a product that would typically have a material cost to
a provider of $25 to $45. The options for a provider become:
1.Continue to provide a good product and comprehensive professional service
and hope that you can continue to stay in business
2. Find less expensive products. In most cases they are less expensive for a
reason
3. Provide little or no service
Two of the other allowables were significantly increased, those for
K0640 and K0646. I am hoping someone can compare the descriptors for these two
codes and for K0648 and explain what different devices these are supposed to
represent. K0648 was AOPA's crosswalk recommendation from L0565, which I
interpreted to be a typical prefabricated plastic LSO.
This is all bad enough if it were just Medicare but what happens when the
codes and allowables become permanent and then trickle down to the private
payers?
Tom Heckman CO
Thoughts on LSO K-codes
When discussing the LSO K-codes and allowables, it is hard to know where to
begin. First, new codes and descriptors were established to more narrowly
define how devices could be coded. Some of the new descriptors are relatively
straighforward crosswalks of previous codes, and some are indecipherable and / or
virtually identical to others. Then, allowables were established essentially
by finding inexpensive products that could be considered examples of codes,
and using the cost of those products plus a minimal markup as the new allowable.
I have a comment about one new code and allowable, and a question about three
others. In the current AOPA in advance, it is noted that allowables for
some of the codes have increased. One of these is K0637, which I interpret to
represent a typical lumbosacral corset with stays, formerly coded with L0500
with a 2003 allowable of $106.76 in Region B. The increased allowable is now
$67.53 (from 64.14), for a product that would typically have a material cost to
a provider of $25 to $45. The options for a provider become:
1.Continue to provide a good product and comprehensive professional service
and hope that you can continue to stay in business
2. Find less expensive products. In most cases they are less expensive for a
reason
3. Provide little or no service
Two of the other allowables were significantly increased, those for
K0640 and K0646. I am hoping someone can compare the descriptors for these two
codes and for K0648 and explain what different devices these are supposed to
represent. K0648 was AOPA's crosswalk recommendation from L0565, which I
interpreted to be a typical prefabricated plastic LSO.
This is all bad enough if it were just Medicare but what happens when the
codes and allowables become permanent and then trickle down to the private
payers?
Tom Heckman CO
Citation
“LSO K codes,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/223647.
